Is the severity of obstructive sleep apnoea associated with the degree of insulin resistance?
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Biomedical subjects
Publications and source records attributed to G Nomura.
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We describe a type 2 diabetic patient who showed immediate-type allergy against human insulin associated with marked eosinophilia at initial insulin therapy. Three months after initiation of insulin therapy, he noticed itchy skin wheals at the site of the insulin injection. Laboratory data at that time showed marked eosinophilia (2,512 /mm3) and progression of renal dysfunction. Skin test with semisynthetic human insulin and protamine sulfate resulted in local immediate skin reactions such as itchy erythema and wheals. Histopathology of the biopsy specimen from skin showed perivascular infiltration of lymphocytes and numerous eosinophils in the dermis and subcutaneous fat. Although the titer of total IgE antibody was within normal range, that of insulin-specific IgE antibody was high. Insulin administration was discontinued to preserve his insulin secretion, and stable control of his hyperglycemia was obtained by initiating nateglinide treatment (360 mg/day). His itchy skin lesions disappeared within two weeks after cessation of the insulin therapy and both eosinophilia and renal dysfunction gradually improved. Although the widespread use of human insulin in diabetic patients has greatly reduced the incidence of insulin allergy, the possibility of human insulin allergy should be kept in mind when initiating such therapy.
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Ion-cyclotron heating was applied to the Large Helical Device. When the proton-cyclotron resonance was near the saddle point of the magnetic field-strength plane, strong ion-cyclotron damping occurred. Under these conditions efficient plasma heating was achieved for more than one minute. A high-energy ion tail was observed, and the effective tail temperature was determined by a balance between the wave acceleration and the electron-drag relaxation. There was no apparent sign of particle orbit loss effect in the investigated density range of 0.8-1.3x10(19) m(-3).
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Given that the NcoI polymorphism of the tumor necrosis factor-beta (TNF-beta) gene has been shown to be associated with tumor necrosis factor-alpha (TNF-alpha) secretory capacity, we know that this TNF-beta gene polymorphism may influence insulin resistance. In Caucasians, 2 polymorphisms of the TNF-alpha promoter region (positions -308 and -238) have been reported to be associated with insulin resistance. Thus, we investigated how genetic variation in the TNF-beta and TNF-alpha genes was associated with insulin resistance in 211 Japanese men. The frequency of the TNF-beta gene polymorphism was 0.41, and insulin resistance, estimated by homeostasis model assessment (HOMA), was significantly lower in variant homozygotes versus wild-type allele. The frequencies of the -308 and -238 polymorphisms were 0.01 and 0.02, respectively, and these polymorphisms were not associated with insulin resistance. Our results suggest that the TNF-beta gene polymorphism decreases insulin resistance, and that the -308 and -238 polymorphisms of the TNF-alpha promoter region are not a major contributing factor to insulin resistance in Japanese men.
The beta2-adrenergic receptor (beta2AR), beta3AR, or uncoupling protein 1 (UCP1) may play a pathogenic role in obesity. In Swedish Caucasians, a polymorphism at codon 27 (Gln27Glu) of the beta2AR gene was shown to be associated with obesity, but no such association was shown for a polymorphism of codon 16 (Arg16Gly). Thus, we investigated whether these polymorphisms contribute to obesity in 210 Japanese men. The frequencies of the Gln27Glu and Arg16Gly polymorphisms were 0.05 and 0.48, respectively, and there was no association with obesity. A strong linkage disequilibrium between the Gln27Glu and Arg16Gly polymorphisms was shown, but there was no apparent additive effect on the clinical or metabolic characteristics. Our results suggest that the Gln27Glu and Arg16Gly polymorphisms of the beta2AR gene are not a major contributing factor to obesity in Japanese men.
OBJECTIVE: In hypertensive subjects, exercise training is a therapeutic modality that not only lowers blood pressure but also corrects metabolic abnormality, such as hyperinsulinemia. Insulin causes sympatho-excitation via the modification of baroreflex, norepinephrine release, or central sympathetic outflow. However, the link between neural and metabolic changes by exercise training in hypertensive patients remains unknown. The aim of this study was to examine whether or not the blood pressure lowering effect of exercise training is associated with the improvement of insulin sensitivity in conjunction with the inhibition of sympathetic tone in hypertensive patients. METHODS: We evaluated plasma insulin levels, arterial baroreflex function and humoral parameters before and after exercise training. Twenty-nine patients with essential hypertension under hospitalization participated in the study. Before and after three weeks of exercise training (75% max VO2, 6 min, q.i.d.), 24-hour blood pressure recordings, arterial baroreflex function testing and 75 g glucose tolerance tests were conducted. Area under the curve of insulin (sigma insulin) to glucose load was calculated as an index of hyperinsulinemia. RESULTS: Three weeks of exercise training decreased the 24-hour mean arterial pressure, heart rate and sigma insulin, and improved barorefiex function. There was a significant correlation between the reduction of arterial pressure and the change in sigma insulin. Furthermore, the reduction of sigma insulin was correlated with the improvement of baroreflex function and with the decrease in heart rate. CONCLUSIONS: Exercise training lowered the arterial pressure, with parallel changes in heart rate, baroreflex function and insulin resistance. The correction of sympathetic overactivity was closely associated with the amelioration of hyperinsulinemia. Our results suggest that the improvement of neuro-metabolic factors may be involved in the depressor effect caused by exercise training.
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The Trp64Arg mutation of the beta3-adrenergic receptor (beta3AR) gene and A to G polymorphism of the uncoupling protein 1 (UCP1) gene are reported to be associated with weight gain, and both have been shown to have an additive effect on weight gain in Caucasians. Racial differences have also been noted in the beta3AR mutation; however, the effect of UCP1 polymorphism on body weight is not obvious in the Japanese. Thus, we investigated the association of genetic variations in beta3AR and UCP1 genes and the additive effects of these two genes in 214 Japanese men. The frequency of the Trp64Arg allele was 0.19, and serum triglyceride was significantly higher in Arg64 homozygotes versus Trp64 homozygotes. The frequency of the G allele was 0.51, and the body mass index (BMI) was significantly higher in subjects with the G allele (GG homozygotes and AG heterozygotes) versus those without it (AA homozygotes). The beta3AR mutation and UCP1 polymorphism were not found to have additive effects, and they were not related to glucose tolerance patterns and insulin resistance. Our results suggest that the beta3AR mutation is associated with hypertriglyceridemia and the UCP1 polymorphism may be a weak contributing factor to obesity in Japanese men.
An alanine to threonine substitution at codon 54 of the fatty acid binding protein 2 (FABP2) gene has been associated with insulin resistance in Pima Indians and with obesity in aboriginal Canadians. We investigated whether this polymorphism contributes to obesity and insulin resistance in 258 Japanese subjects. Thirty-six subjects (13.9%) were homozygous for the Thr54 allele, 106 (41.1%) were heterozygous for the Ala54/Thr54 allele, and 116 (45.0%) were homozygous for the Ala54 allele. The frequency of the Thr54 allele was 0.34 and did not differ significantly between men and women. The incidence of non-insulin-dependent diabetes mellitus (NIDDM) was not different among the three genotypes. The variation at codon 54 of the FABP2 gene was not associated with obesity, hypertension, dyslipidemia, hyperuricemia, or hyperinsulinemia. These results suggest that the polymorphism at codon 54 of the FABP2 gene is not a major contributing factor to obesity and insulin resistance in Japanese subjects.
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A 24-year-old woman who visited our hospital because of urticaria had a bronchial asthma attack about 5 min. after receiving Stronger Neo-Minophagen C (SNMC) intravenously. A skin test for SNMC and its components (glycyrrhizin, L-cystein, aminoacetic acid, and sodium sulfite) was positive for SNMC and borderline for sodium sulfite after 15 min. A skin test for mixtures of L-cystein and sodium sulfite was also positive. Inhalation provocation tests for SNMC and mixtures of L-cystein and sodium sulfite were positive after 5 min. An inhalation provocation test for sulpyrin was also positive. The patient's bronchial asthma attack was ascribed to SNMC. Type I allergy to mixtures of L-cystein and sodium sulfite was the suspected cause.
To clarify characteristics of the patients in whom exercise training lowers blood pressure and to elucidate the mechanisms by which exercise training lowers blood pressure, we evaluated 24-h blood pressure, glomerular filtration rate (GFR), renal blood flow (RBF), filtration fraction (FF), plasma renin activity (PRA), plasma aldosterone concentration (PAC), plasma norepinephrine concentration (PNE), and incremental area of insulin/glucose (sigmaI/sigmaG) during 75 g oral glucose tolerance test, and assessed arterial baroreceptor function (BSI) before and after a 3-week exercise training program (four 6-min sessions daily at 75% VO2 max). Patients were classified as responders (n = 15) if they showed statistically significant reduction in the multiple comparison of 24-h mean arterial pressure (MAP), or as nonresponders (n = 15) if they did not. Although there were no significant differences between responders and nonresponders in age, weight, MAP, GFR, RBF, RPF, FF, PNE, sigmaI/sigmaG, or BSI before exercise, renal vascular resistance (RVR; P < .05), PRA (P < .05), and PAC (P < .05) were significantly higher in responders than in nonresponders. The fractional excretion of sodium (FENa) (P < .05) were significantly lower in responders than in nonresponders. After exercise training, FF (P < .01), RVR (P < .05), PNE (P < .05) PRA (P < .01), and sigmaI/sigmaG (P < .05) decreased significantly only in responders. The decrease in MAP significantly correlated with the reductions in FF (r = 0.46, P < .05), PNE (r = 0.52, P < .01) and RVR (r = 0.40, P < .05). Thus, in patients who have higher RVR and PRA, exercise training lowered blood pressure in parallel to a reduction in RVR associated with decreases in sympathetic tone and improvement of insulin resistance. Our results suggest that exercise-induced changes in renal hemodynamics may contribute to the reduction in blood pressure in these patients.
In this study, we investigated the carcinogenic response of transgenic mice carrying the human prototype c-Ha-ras gene, namely Tg rasH2/CB6F1 mice, to various genotoxic carcinogens and compared it with that of control non-transgenic CB6F1 mice (non-Tg mice). The present studies were conducted as the first step in the evaluation of the Tg rasH2/CB6F1 mouse as a model for the rapid carcinogenicity testing system. Short-term (< or = 6 months) rapid carcinogenicity tests of various genotoxic carcinogens, 4-nitroquinoline-1-oxide, cyclophosphamide, N,N-diethylnitrosamine, N-methyl-N-nitrosourea, N-methyl-N'-nitro-N-nitrosoguanidine and methylazoxymethanol, revealed that Tg rasH2/CB6F1 mice are more susceptible to these genotoxic carcinogens than control non-Tg mice. Tg rasH2/CB6F1 mice developed tumors more rapidly compared with non-Tg mice. Malignant tumors were observed only in the carcinogen-treated Tg rasH2/CB6F1 mice, but not in non-Tg mice treated with the same carcinogens. Each carcinogen induced tumors in corresponding target tissues of the Tg rasH2/CB6F1 mice. Only a very few lung adenomas but no other tumors were seen as spontaneous tumors during the 6 months of carcinogenicity tests. These results demonstrate that more rapid onset and higher incidence of more malignant tumors can be expected with high probability after treatment with various genotoxic carcinogens in the Tg rasH2/CB6F1 mice than in control non-Tg mice. The Tg rasH2/CB6F1 mouse seems to be a promising candidate as an animal model for the development of a rapid carcinogenicity testing system.